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PLoS One. 2019 May 15;14(5):e0216680. doi: 10.1371/journal.pone.0216680. eCollection 2019.

HIV infection is associated with elevated biomarkers of immune activation in Ugandan adults with pneumonia.

Author information

1
Department of Medicine, University of California San Francisco, San Francisco, California, United States of America.
2
Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, United States of America.
3
Department of Statistics, University of California Davis, Davis, California, United States of America.
4
Makerere University - University of California San Francisco Research Collaboration, Infectious Diseases Research Collaboration, Kampala, Uganda.
5
Department of Internal Medicine, Makerere College of Health Sciences, Kampala, Uganda.
6
Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America.
7
Department of Medicine, University of Washington School of Medicine, Seattle, Washington, United States of America.
8
Department of Biochemistry and Biophysics, University of California San Francisco, San Francisco, California, United States of America.

Abstract

INTRODUCTION:

Pneumonia is an important cause of morbidity and mortality in persons living with human immunodeficiency virus (HIV) infection. How immune activation differs among HIV-infected and HIV-uninfected adults with pneumonia is unknown.

METHODS:

The Inflammation, Aging, Microbes, and Obstructive Lung Disease (I AM OLD) Cohort is a prospective cohort of adults with pneumonia in Uganda. In this cross-sectional analysis, plasma was collected at pneumonia presentation to measure the following 12 biomarkers: interleukin 6 (IL-6), soluble tumor necrosis factor receptors 1 and 2 (sTNFR-1 and sTNFR-2), high sensitivity C-reactive protein (hsCRP), fibrinogen, D-dimer, soluble CD27 (sCD27), interferon gamma-inducible protein 10 (IP-10), soluble CD14 (sCD14), soluble CD163 (sCD163), hyaluronan, and intestinal fatty acid binding protein. We asked whether biomarker levels differed between HIV-infected and HIV-uninfected participants, and whether higher levels of these biomarkers were associated with mortality.

RESULTS:

One hundred seventy-three participants were enrolled. Fifty-three percent were HIV-infected. Eight plasma biomarkers-sTNFR-1, sTNFR-2, hsCRP, D-dimer, sCD27, IP-10, sCD14, and hyaluronan-were higher among participants with HIV infection, after adjustment for pneumonia severity. Higher levels of 8 biomarkers-IL-6, sTNFR-1, sTNFR-2, hsCRP, IP-10, sCD14, sCD163, and hyaluronan-were associated with increased 2-month mortality.

CONCLUSIONS:

As in other clinical contexts, HIV infection is associated with a greater degree of immune activation among Ugandan adults with pneumonia. Some of these are also associated with short-term mortality. Further study is needed to explore whether these biomarkers might predict poor long-term outcomes-such as the development of obstructive lung disease-in patients with HIV who have recovered from pneumonia.

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